It’s critical to identify which type of headache you suffer from—tension, cluster, sinus, rebound, or migraine—so that the correct treatment can be prescribed. In one 2004 study, 80% of patients with a recent history of self-described or doctor-diagnosed sinus headache—but none of the signs of sinus infection—actually met the criteria for migraine. And two-thirds of those patients expressed dissatisfaction with the medications they were using to treat their headaches. Here’s a cheat sheet to help you put a name to your pain.
Take the Migraine Quiz: Find out what really triggers that debilitating pain in your head.
Tension headaches, the most common type, feel like a constant ache or pressure around the head, especially at the temples or back of the head and neck. Not as severe as migraines, they are not usually accompanied by nausea and vomiting, and they rarely stop someone from continuing their regular activities. Over-the-counter treatments, such as aspirin, ibuprofen, or acetaminophen (Tylenol), are usually sufficient to treat tension headaches, which experts believe may be caused by contraction of neck and scalp muscles (including in response to stress), and possibly changes in brain chemicals.
Cluster headaches, which affect men more often than women, are recurring headaches that occur in groups or cycles. The headaches appear suddenly and are characterized by severe, debilitating pain on one side of the head often accompanied by a watery eye and nasal congestion or a runny nose on the same side of the face. During an attack, sufferers are often restless and unable to get comfortable and not likely to lay down the way someone with a migraine usually does. The cause of cluster headaches is unknown, but they may have some genetic component. There is no cure, but medications can reduce the frequency and duration of attacks.
When a sinus becomes inflamed, usually through an infection, it can cause pain. It usually comes with a fever, and can—if necessary—be diagnosed by MRI or CT scan (which can both detect changes in fluid levels), or by the presence of pus viewed through a fiber-optic scope. Headaches due to sinus infection can be treated with antibiotics, as well as antihistamines or decongestants.
Overuse of painkillers for headaches can, ironically, lead to rebound headaches. Culprits include over-the-counter medications like aspirin, acetaminophen (Tylenol), or ibuprofen (Motrin, Advil), as well as prescription drugs.
“Most of the patients we see in a headache center with daily headache have medication-overuse, or rebound, headaches,” says Stewart Tepper, MD, director of research at the Center for Headache and Pain at the Cleveland Clinic Neurological Institute.
“They are on a merry-go-round and they can’t get off,” says Dr. Tepper. “They keep taking more medicine, they keep having more headaches, and so the patient becomes more and more desperate. That’s when they end up coming to headache specialists to kind of reset the whole system.”
One theory is that too much medication can cause the brain to shift into an excited state, triggering more headaches. Another is that the headaches are a symptom of withdrawal as the level of medicine drops in the bloodstream.
Migraine headaches come from a neurological disorder that can run in families and are defined by certain criteria.
- At least five previous episodes of headaches
- Lasting between four hours and 72 hours
- Having at least two out of four of these features: one-sided pain, throbbing pain, moderate-to-severe pain, and pain that interferes with, is worsened by, or prohibits routine activity
- Having at least one associated feature: nausea and/or vomiting, or, if those are not present, then sensitivity to light and sound
An oncoming migraine attack may, for some, be foreshadowed by an aura, which can include visual distortions (such as wavy lines or blind spots) or numbness of a hand. It’s estimated, though, that only 15% to 20% of migraineurs experience this.